|
LACTATED RINGERS EYE BOLUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
300324
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$57.26
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.26
|
| Rate for Payer: Priority Health Narrow Network |
$49.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR Commercial |
$65.16
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$54.74
|
| Rate for Payer: BCBS Trust/PPO |
$56.98
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.10
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
LACTATED RINGERS INTRAVENOUS SOLUTION
|
Facility
|
OP
|
$67.18
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
4318
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.87 |
| Max. Negotiated Rate |
$67.18 |
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: ASR Commercial |
$65.16
|
| Rate for Payer: BCBS Complete |
$26.87
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$55.01
|
| Rate for Payer: BCBS Trust/PPO |
$57.26
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.10
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.26
|
| Rate for Payer: Priority Health Narrow Network |
$49.01
|
| Rate for Payer: Priority Health Narrow Network |
$47.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
|
|
LACTATED RINGERS IV BOLUS
|
Facility
|
OP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
400296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.97 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$57.26
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.26
|
| Rate for Payer: Priority Health Narrow Network |
$49.01
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
LACTATED RINGERS IV BOLUS
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
400296
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$56.98
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
LACTATED RINGERS IV -DKA
|
Facility
|
OP
|
$67.18
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
301462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.87 |
| Max. Negotiated Rate |
$67.18 |
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: ASR Commercial |
$65.16
|
| Rate for Payer: BCBS Complete |
$26.87
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$55.01
|
| Rate for Payer: BCBS Trust/PPO |
$57.26
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.10
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.26
|
| Rate for Payer: Priority Health Narrow Network |
$49.01
|
| Rate for Payer: Priority Health Narrow Network |
$47.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
|
|
LACTATED RINGERS IV -DKA
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
301462
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR Commercial |
$65.16
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$54.74
|
| Rate for Payer: BCBS Trust/PPO |
$56.98
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.10
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
LACTATED RINGERS IV INFUSION/BOLUS (CODE)
|
Facility
|
OP
|
$67.18
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
163717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.87 |
| Max. Negotiated Rate |
$67.18 |
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Medicare |
$33.59
|
| Rate for Payer: Aetna Medicare |
$34.96
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: ASR Commercial |
$65.16
|
| Rate for Payer: BCBS Complete |
$26.87
|
| Rate for Payer: BCBS Complete |
$27.97
|
| Rate for Payer: BCBS Trust/PPO |
$55.01
|
| Rate for Payer: BCBS Trust/PPO |
$57.26
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.10
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$58.86
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$61.26
|
| Rate for Payer: Priority Health Narrow Network |
$49.01
|
| Rate for Payer: Priority Health Narrow Network |
$47.09
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
|
|
LACTATED RINGERS IV INFUSION/BOLUS (CODE)
|
Facility
|
IP
|
$69.92
|
|
|
Service Code
|
HCPCS J7120
|
| Hospital Charge Code |
163717
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.45 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$62.93
|
| Rate for Payer: Aetna Commercial |
$60.46
|
| Rate for Payer: ASR ASR |
$65.16
|
| Rate for Payer: ASR ASR |
$67.82
|
| Rate for Payer: ASR Commercial |
$65.16
|
| Rate for Payer: ASR Commercial |
$67.82
|
| Rate for Payer: BCBS Trust/PPO |
$54.74
|
| Rate for Payer: BCBS Trust/PPO |
$56.98
|
| Rate for Payer: BCN Commercial |
$54.21
|
| Rate for Payer: BCN Commercial |
$52.08
|
| Rate for Payer: Cash Price |
$55.94
|
| Rate for Payer: Cash Price |
$53.75
|
| Rate for Payer: Cofinity Commercial |
$63.15
|
| Rate for Payer: Cofinity Commercial |
$65.72
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$53.74
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$55.94
|
| Rate for Payer: Healthscope Commercial |
$67.18
|
| Rate for Payer: Healthscope Commercial |
$69.92
|
| Rate for Payer: Healthscope Whirlpool |
$67.82
|
| Rate for Payer: Healthscope Whirlpool |
$65.16
|
| Rate for Payer: Mclaren Commercial |
$60.46
|
| Rate for Payer: Mclaren Commercial |
$62.93
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$59.43
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$57.10
|
| Rate for Payer: Nomi Health Commercial |
$57.33
|
| Rate for Payer: Nomi Health Commercial |
$55.09
|
| Rate for Payer: Priority Health Cigna Priority Health |
$43.67
|
| Rate for Payer: Priority Health Cigna Priority Health |
$45.45
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$59.12
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$61.53
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$2.59
|
|
|
Service Code
|
NDC 50383077933
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: Aetna Medicare |
$1.29
|
| Rate for Payer: ASR ASR |
$2.51
|
| Rate for Payer: ASR Commercial |
$2.51
|
| Rate for Payer: BCBS Complete |
$1.04
|
| Rate for Payer: BCBS Trust/PPO |
$2.12
|
| Rate for Payer: BCN Commercial |
$2.01
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Healthscope Whirlpool |
$2.51
|
| Rate for Payer: Mclaren Commercial |
$2.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.20
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.68
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$2.27
|
| Rate for Payer: Priority Health Narrow Network |
$1.82
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.28
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$6.05
|
|
|
Service Code
|
NDC 00116400530
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Aetna Commercial |
$5.45
|
| Rate for Payer: Aetna Medicare |
$3.02
|
| Rate for Payer: ASR ASR |
$5.87
|
| Rate for Payer: ASR Commercial |
$5.87
|
| Rate for Payer: BCBS Complete |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$4.95
|
| Rate for Payer: BCN Commercial |
$4.69
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cofinity Commercial |
$5.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.84
|
| Rate for Payer: Healthscope Commercial |
$6.05
|
| Rate for Payer: Healthscope Whirlpool |
$5.87
|
| Rate for Payer: Mclaren Commercial |
$5.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.14
|
| Rate for Payer: Nomi Health Commercial |
$4.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.30
|
| Rate for Payer: Priority Health Narrow Network |
$4.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.32
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$4.61
|
|
|
Service Code
|
NDC 50383077930
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.84 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Aetna Commercial |
$4.15
|
| Rate for Payer: Aetna Medicare |
$2.31
|
| Rate for Payer: ASR ASR |
$4.47
|
| Rate for Payer: ASR Commercial |
$4.47
|
| Rate for Payer: BCBS Complete |
$1.84
|
| Rate for Payer: BCBS Trust/PPO |
$3.78
|
| Rate for Payer: BCN Commercial |
$3.57
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.47
|
| Rate for Payer: Mclaren Commercial |
$4.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Nomi Health Commercial |
$3.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.00
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$4.04
|
| Rate for Payer: Priority Health Narrow Network |
$3.23
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.06
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$6.62
|
|
|
Service Code
|
NDC 00121115430
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$6.62 |
| Rate for Payer: Aetna Commercial |
$5.96
|
| Rate for Payer: ASR ASR |
$6.42
|
| Rate for Payer: ASR Commercial |
$6.42
|
| Rate for Payer: BCBS Trust/PPO |
$5.39
|
| Rate for Payer: BCN Commercial |
$5.13
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cofinity Commercial |
$6.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$6.62
|
| Rate for Payer: Healthscope Whirlpool |
$6.42
|
| Rate for Payer: Mclaren Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.63
|
| Rate for Payer: Nomi Health Commercial |
$5.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.83
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$6.62
|
|
|
Service Code
|
NDC 00121115400
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$4.30 |
| Max. Negotiated Rate |
$6.62 |
| Rate for Payer: Aetna Commercial |
$5.96
|
| Rate for Payer: ASR ASR |
$6.42
|
| Rate for Payer: ASR Commercial |
$6.42
|
| Rate for Payer: BCBS Trust/PPO |
$5.39
|
| Rate for Payer: BCN Commercial |
$5.13
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cofinity Commercial |
$6.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$6.62
|
| Rate for Payer: Healthscope Whirlpool |
$6.42
|
| Rate for Payer: Mclaren Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.63
|
| Rate for Payer: Nomi Health Commercial |
$5.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.30
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.83
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$6.05
|
|
|
Service Code
|
NDC 00116400530
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Aetna Commercial |
$5.45
|
| Rate for Payer: ASR ASR |
$5.87
|
| Rate for Payer: ASR Commercial |
$5.87
|
| Rate for Payer: BCBS Trust/PPO |
$4.93
|
| Rate for Payer: BCN Commercial |
$4.69
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cofinity Commercial |
$5.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.84
|
| Rate for Payer: Healthscope Commercial |
$6.05
|
| Rate for Payer: Healthscope Whirlpool |
$5.87
|
| Rate for Payer: Mclaren Commercial |
$5.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.14
|
| Rate for Payer: Nomi Health Commercial |
$4.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.32
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$2.59
|
|
|
Service Code
|
NDC 50383077933
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$2.59 |
| Rate for Payer: Aetna Commercial |
$2.33
|
| Rate for Payer: ASR ASR |
$2.51
|
| Rate for Payer: ASR Commercial |
$2.51
|
| Rate for Payer: BCBS Trust/PPO |
$2.11
|
| Rate for Payer: BCN Commercial |
$2.01
|
| Rate for Payer: Cash Price |
$2.07
|
| Rate for Payer: Cofinity Commercial |
$2.43
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$2.07
|
| Rate for Payer: Healthscope Commercial |
$2.59
|
| Rate for Payer: Healthscope Whirlpool |
$2.51
|
| Rate for Payer: Mclaren Commercial |
$2.33
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$2.20
|
| Rate for Payer: Nomi Health Commercial |
$2.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.68
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$2.28
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$6.05
|
|
|
Service Code
|
NDC 00116400511
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Aetna Commercial |
$5.45
|
| Rate for Payer: ASR ASR |
$5.87
|
| Rate for Payer: ASR Commercial |
$5.87
|
| Rate for Payer: BCBS Trust/PPO |
$4.93
|
| Rate for Payer: BCN Commercial |
$4.69
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cofinity Commercial |
$5.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.84
|
| Rate for Payer: Healthscope Commercial |
$6.05
|
| Rate for Payer: Healthscope Whirlpool |
$5.87
|
| Rate for Payer: Mclaren Commercial |
$5.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.14
|
| Rate for Payer: Nomi Health Commercial |
$4.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.93
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.32
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
IP
|
$4.61
|
|
|
Service Code
|
NDC 50383077930
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.00 |
| Max. Negotiated Rate |
$4.61 |
| Rate for Payer: Aetna Commercial |
$4.15
|
| Rate for Payer: ASR ASR |
$4.47
|
| Rate for Payer: ASR Commercial |
$4.47
|
| Rate for Payer: BCBS Trust/PPO |
$3.76
|
| Rate for Payer: BCN Commercial |
$3.57
|
| Rate for Payer: Cash Price |
$3.69
|
| Rate for Payer: Cofinity Commercial |
$4.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$3.69
|
| Rate for Payer: Healthscope Commercial |
$4.61
|
| Rate for Payer: Healthscope Whirlpool |
$4.47
|
| Rate for Payer: Mclaren Commercial |
$4.15
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$3.92
|
| Rate for Payer: Nomi Health Commercial |
$3.78
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.00
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$4.06
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$6.62
|
|
|
Service Code
|
NDC 00121115430
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$6.62 |
| Rate for Payer: Aetna Commercial |
$5.96
|
| Rate for Payer: Aetna Medicare |
$3.31
|
| Rate for Payer: ASR ASR |
$6.42
|
| Rate for Payer: ASR Commercial |
$6.42
|
| Rate for Payer: BCBS Complete |
$2.65
|
| Rate for Payer: BCBS Trust/PPO |
$5.42
|
| Rate for Payer: BCN Commercial |
$5.13
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cofinity Commercial |
$6.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$6.62
|
| Rate for Payer: Healthscope Whirlpool |
$6.42
|
| Rate for Payer: Mclaren Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.63
|
| Rate for Payer: Nomi Health Commercial |
$5.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.80
|
| Rate for Payer: Priority Health Narrow Network |
$4.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.83
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$6.05
|
|
|
Service Code
|
NDC 00116400511
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.42 |
| Max. Negotiated Rate |
$6.05 |
| Rate for Payer: Aetna Commercial |
$5.45
|
| Rate for Payer: Aetna Medicare |
$3.02
|
| Rate for Payer: ASR ASR |
$5.87
|
| Rate for Payer: ASR Commercial |
$5.87
|
| Rate for Payer: BCBS Complete |
$2.42
|
| Rate for Payer: BCBS Trust/PPO |
$4.95
|
| Rate for Payer: BCN Commercial |
$4.69
|
| Rate for Payer: Cash Price |
$4.84
|
| Rate for Payer: Cofinity Commercial |
$5.69
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$4.84
|
| Rate for Payer: Healthscope Commercial |
$6.05
|
| Rate for Payer: Healthscope Whirlpool |
$5.87
|
| Rate for Payer: Mclaren Commercial |
$5.45
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.14
|
| Rate for Payer: Nomi Health Commercial |
$4.96
|
| Rate for Payer: Priority Health Cigna Priority Health |
$3.93
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.30
|
| Rate for Payer: Priority Health Narrow Network |
$4.24
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.32
|
|
|
LACTULOSE 20 GRAM/30 ML ORAL SOLUTION
|
Facility
|
OP
|
$6.62
|
|
|
Service Code
|
NDC 00121115400
|
| Hospital Charge Code |
150919
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$2.65 |
| Max. Negotiated Rate |
$6.62 |
| Rate for Payer: Aetna Commercial |
$5.96
|
| Rate for Payer: Aetna Medicare |
$3.31
|
| Rate for Payer: ASR ASR |
$6.42
|
| Rate for Payer: ASR Commercial |
$6.42
|
| Rate for Payer: BCBS Complete |
$2.65
|
| Rate for Payer: BCBS Trust/PPO |
$5.42
|
| Rate for Payer: BCN Commercial |
$5.13
|
| Rate for Payer: Cash Price |
$5.30
|
| Rate for Payer: Cofinity Commercial |
$6.22
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$5.30
|
| Rate for Payer: Healthscope Commercial |
$6.62
|
| Rate for Payer: Healthscope Whirlpool |
$6.42
|
| Rate for Payer: Mclaren Commercial |
$5.96
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$5.63
|
| Rate for Payer: Nomi Health Commercial |
$5.43
|
| Rate for Payer: Priority Health Cigna Priority Health |
$4.30
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$5.80
|
| Rate for Payer: Priority Health Narrow Network |
$4.64
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$5.83
|
|
|
LAMOTRIGINE 200 MG TABLET
|
Facility
|
IP
|
$183.30
|
|
|
Service Code
|
NDC 51672413304
|
| Hospital Charge Code |
13983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$119.14 |
| Max. Negotiated Rate |
$183.30 |
| Rate for Payer: Aetna Commercial |
$164.97
|
| Rate for Payer: ASR ASR |
$177.80
|
| Rate for Payer: ASR Commercial |
$177.80
|
| Rate for Payer: BCBS Trust/PPO |
$149.37
|
| Rate for Payer: BCN Commercial |
$142.11
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Commercial |
$172.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Healthscope Commercial |
$183.30
|
| Rate for Payer: Healthscope Whirlpool |
$177.80
|
| Rate for Payer: Mclaren Commercial |
$164.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.14
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.30
|
|
|
LAMOTRIGINE 200 MG TABLET
|
Facility
|
IP
|
$88.83
|
|
|
Service Code
|
NDC 65862023060
|
| Hospital Charge Code |
13983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$57.74 |
| Max. Negotiated Rate |
$88.83 |
| Rate for Payer: Aetna Commercial |
$79.95
|
| Rate for Payer: ASR ASR |
$86.17
|
| Rate for Payer: ASR Commercial |
$86.17
|
| Rate for Payer: BCBS Trust/PPO |
$72.39
|
| Rate for Payer: BCN Commercial |
$68.87
|
| Rate for Payer: Cash Price |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$83.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.06
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Healthscope Whirlpool |
$86.17
|
| Rate for Payer: Mclaren Commercial |
$79.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.51
|
| Rate for Payer: Nomi Health Commercial |
$72.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.74
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.17
|
|
|
LAMOTRIGINE 200 MG TABLET
|
Facility
|
OP
|
$88.83
|
|
|
Service Code
|
NDC 65862023060
|
| Hospital Charge Code |
13983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.53 |
| Max. Negotiated Rate |
$88.83 |
| Rate for Payer: Aetna Commercial |
$79.95
|
| Rate for Payer: Aetna Medicare |
$44.41
|
| Rate for Payer: ASR ASR |
$86.17
|
| Rate for Payer: ASR Commercial |
$86.17
|
| Rate for Payer: BCBS Complete |
$35.53
|
| Rate for Payer: BCBS Trust/PPO |
$72.74
|
| Rate for Payer: BCN Commercial |
$68.87
|
| Rate for Payer: Cash Price |
$71.06
|
| Rate for Payer: Cofinity Commercial |
$83.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$71.06
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Healthscope Whirlpool |
$86.17
|
| Rate for Payer: Mclaren Commercial |
$79.95
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$75.51
|
| Rate for Payer: Nomi Health Commercial |
$72.84
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.74
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$77.83
|
| Rate for Payer: Priority Health Narrow Network |
$62.27
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$78.17
|
|
|
LAMOTRIGINE 200 MG TABLET
|
Facility
|
OP
|
$183.30
|
|
|
Service Code
|
NDC 51672413304
|
| Hospital Charge Code |
13983
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$73.32 |
| Max. Negotiated Rate |
$183.30 |
| Rate for Payer: Aetna Commercial |
$164.97
|
| Rate for Payer: Aetna Medicare |
$91.65
|
| Rate for Payer: ASR ASR |
$177.80
|
| Rate for Payer: ASR Commercial |
$177.80
|
| Rate for Payer: BCBS Complete |
$73.32
|
| Rate for Payer: BCBS Trust/PPO |
$150.10
|
| Rate for Payer: BCN Commercial |
$142.11
|
| Rate for Payer: Cash Price |
$146.64
|
| Rate for Payer: Cofinity Commercial |
$172.30
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$146.64
|
| Rate for Payer: Healthscope Commercial |
$183.30
|
| Rate for Payer: Healthscope Whirlpool |
$177.80
|
| Rate for Payer: Mclaren Commercial |
$164.97
|
| Rate for Payer: Multiplan/Beech St/PHCS Commercial |
$155.81
|
| Rate for Payer: Nomi Health Commercial |
$150.31
|
| Rate for Payer: Priority Health Cigna Priority Health |
$119.14
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$160.61
|
| Rate for Payer: Priority Health Narrow Network |
$128.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) + Core |
$161.30
|
|
